Out of State Inpatient Rates effective 03/13/14
- Out of State APR-DRG and Exempt Unit Rates effective 03/13/2014 (XSL, 151KB) Also available in PDF Format (PDF, 56KB)
| Hospital Name | City | State | Rate Code 2953 (OOS Hospital DRG) | Rate Code 2952 (OOS Hospital Exempt) | Rate Code 2589 (DME Add-on) | Rate Code 2950 and 2954 (ALC RHCF) | Rate Code 2951 and 2955 (ALC Home Care) | Rate Code 2990 (Capital per Disch) | Rate Code 2991 (Capital per Diem) | WEF/ISAF (for High Cost Claims) | High Cost Charge Convertors |
|---|---|---|---|---|---|---|---|---|---|---|---|
| BAPTIST MEM HOSP OF MEMPHIS | MEMPHIS | TN | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| BAYLOR ALL SAINTS MED CTR TX | FORT WORTH | TX | $ 7,336.96 | $ - | $ - | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| BAYLOR UNIVERSITY MED CTR TX | DALLAS | TX | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| BETH ISRAEL DEACONESS BOSTON | BOSTON | MA | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| BOSTON MEDICAL CENTER MA | BOSTON | MA | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| BRIGHAM AND WOMENS HOSP | BOSTON | MA | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| CARONDELET ST MARYS HOSP AZ | TUCSON | AZ | $ 7,336.96 | $ - | $ - | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| CENTENNIAL HILLS HOSP MED CTR | LAS VEGAS | NV | $ 7,336.96 | $ - | $ - | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| CENTENNIAL MED CTR TN | NASHVILLE | TN | $ 7,336.96 | $ - | $ - | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| CHILDRENS HOSP OF PHILA PA | PHILADELPHIA | PA | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| CHILDRENS HOSPITAL MA | BOSTON | MA | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| CHILDRENS HOSPITAL SAN DIEGO | SAN DIEGO | CA | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| CHILDRENS NATIONAL MED CTR | WASHINGTON | DC | $ 7,336.96 | $ - | $ - | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| DANA FARBER CANCER INSTITUTE | BOSTON | MA | $ 7,336.96 | $ - | $ - | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| DOCTORS HOSPITAL TX | DALLAS | TX | $ 7,336.96 | $ - | $ - | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| EHS TRINITY HOSP IL | CHICAGO | IL | $ 7,336.96 | $ - | $ - | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| FRANKLIN SQUARE HOSP MD | BALTIMORE | MD | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| GEORGETOWN UNIVERSITY HOSP DC | WASHINGTON | DC | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| GREATER BALTIMORE MED CTR MD | BALTIMORE | MD | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| HARBORVIEW MED CTR WA | SEATTLE | WA | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| HOSPITAL OF THE UNIV OF PENN | PHILADELPHIA | PA | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| ILLINOIS MASONIC MED CTR IL | CHICAGO | IL | $ 7,336.96 | $ - | $ - | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| JEANES HOSPITAL PA | PHILADELPHIA | PA | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| JOHN C LINCOLN DEERVALLEY AZ | PHOENIX | AZ | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| JOHN C LINCOLN HOSP HLTH AZ | PHOENIX | AZ | $ 7,336.96 | $ - | $ - | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| JOHNS HOPKINS HOSPITAL MD | BALTIMORE | MD | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| KENNEDY KRIEGER INSTITUTE MD | BALTIMORE | MD | $ 7,336.96 | $ - | $ - | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| KOSAIR CHILDRENS HSP KY | LOUISVILLE | KY | $ 7,336.96 | $ - | $ - | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| MASSACHUSETTS GEN HOSP | BOSTON | MA | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| MEDICAL CITY DALLAS HOSP TX | DALLAS | TX | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| MEMORIAL HERMANN HOSP TX | HOUSTON | TX | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| MEMORIAL HERMANN SE & SW HOSP | HOUSTON | TX | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| MERCY MEDICAL CENTER MD | BALTIMORE | MD | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| METHODIST CHARLTON MED CTR | DALLAS | TX | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| METHODIST HOSP OF MEMPHIS TN | MEMPHIS | TN | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| METHODIST IU RILEY HOSPITAL | INDIANAPOLIS | IN | $ 7,336.96 | $ - | $ - | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| NORTH PHILADELPHIA HLTH SYS | PHILADELPHIA | PA | $ 7,336.96 | $ - | $ - | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| OHIO STATE UNIVERSITY HSP OH | COLUMBUS | OH | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| OU MEDICAL CENTER OK | OKLAHOMA CITY | OK | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| PENNSYLVANIA HOSP PA | PHILADELPHIA | PA | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| PRESBYTERIAN HOSP NM | ALBUQUERQUE | NM | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| PRESBYTERIAN HSP OF DALLAS | DALLAS | TX | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| REGIONAL MED CTR AT MEMPHIS | MEMPHIS | TN | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| RUSH UNIVERSITY MED CTR IL | CHICAGO | IL | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| RUSH UNIVERSITY MED CTR IL | CHICAGO | IL | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| RUSH UNIVERSITY MED CTR IL | CHICAGO | IL | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| SAINT FRANCIS HOSPITAL TN | MEMPHIS | TN | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| SHARP MEM HSP CA | SAN DIEGO | CA | $ 7,336.96 | $ - | $ - | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| SHRINERS HSP FOR CHILDREN PA | PHILADELPHIA | PA | $ 7,336.96 | $ - | $ - | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| SINAI GRACE HOSPITAL MI | DETROIT | MI | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| SOUTHERN HILLS M C TN | NASHVILLE | TN | $ 7,336.96 | $ - | $ - | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| SPRING VALLEY HOSP MED NV | LAS VEGAS | NV | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| SPRING VALLEY HOSP MED NV | LAS VEGAS | NV | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| ST CHRISTOPHERS HSP CHILD PA | PHILADELPHIA | PA | $ 7,336.96 | $ - | $ - | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| ST JUDE CHILDRENS RES HSP TN | MEMPHIS | TN | $ 7,336.96 | $ - | $ - | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| ST LUKES HOSPITAL | MILWAUKEE | WI | $ 7,336.96 | $ - | $ - | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| STEWARD ST ELIZABETH MED CTR | BOSTON | MA | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| SUMMERLIN MED CTR NV | LAS VEGAS | NV | $ 7,336.96 | $ - | $ - | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| SUNRISE HOSP & MED CTR NV | LAS VEGAS | NV | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| TEMPLE UNIVERSITY HOSPITAL | PHILADELPHIA | PA | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| TEXAS CHILDREN'S HOSP TX | HOUSTON | TX | $ 7,336.96 | $ - | $ - | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| TEXAS HLTH HARRIS METH HSP | FORT WORTH | TX | $ 7,336.96 | $ - | $ - | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| THE SHRINERS HOSP FOR CHILD MA | BOSTON | MA | $ 7,336.96 | $ - | $ - | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| THOMAS JEFFERSON UNIV HOSP PA | PHILADELPHIA | PA | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| UCSD MEDICAL CENTER | SAN DIEGO | CA | $ 7,336.96 | $ - | $ - | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| UNIV OF WASHINGTON WA | SEATTLE | WA | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| UNIVERSITY OF MARYLAND MED SY | BALTIMORE | MD | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| UNIVERSITY SPECIALTY HOSP MD | BALTIMORE | MD | $ 7,336.96 | $ - | $ - | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| UPHS PRESBYTERIAN MEDICAL CEN | PHILADELPHIA | PA | $ 7,336.96 | $ - | $ - | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| VANDERBILT UNIVERSITY HSP TN | NASHVILLE | TN | $ 8,832.97 | $ - | $ 1,295.15 | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
| VHS CHILDRENS HSP MI | DETROIT | MI | $ 7,336.96 | $ - | $ - | $ 261.20 | $ 261.20 | $ 767.27 | $ 153.65 | 1.0684 | 0.357482 |
Notes
Information Regarding Out of State Inpatient Rates effective 3/13/14
The Department of Health obtained approval from CMS and updated Part 86-1.33 (1)(ii) of Title 10 of the New York Codes, Rules and Regulations for the following expansion of the "downstate" designation for rate assignments. Due to the delay in the Federal Public Notice, the effective date is March 13, 2014.
(1) (i) The weighted average of inpatient rates, including a teaching adjustment where applicable, in effect for similar services for hospitals located in the downstate region of New York State shall apply with regard to services provided by out-of-state providers located in the New Jersey counties of Sussex, Passaic, Bergin, Hudson, Essex, Union, Middlesex and Monmouth, in the Pennsylvania county of Pike, and in the Connecticut counties of Fairfield and Litchfield.
(ii) For rates effective beginning January 1, 2014, the weighted average of inpatient rates, including a teaching adjustment where applicable, in effect for similar services for hospitals located in the downstate region of New York State shall also apply with regard to services provided by out-of-state providers located in cities where the city´s population census is 500,000 or greater based on the U.S. Department of Commerce United States Census Bureau; and
(2) The weighted average of inpatient rates, including a teaching adjustment where applicable, in effect for similar services for hospitals located in the upstate region of New York State shall apply with regard to all other out-of-state providers.
(3) High cost outlier rates of payment shall be calculated in accordance with 86-1.21 with the exception of the wage equalization factor (WEF) being based upon the weighted average of the upstate or downstate region.
(4) The weighted average of the capital component of the inpatient rates in effect for similar services for hospitals located in New York State shall apply with regard to services provided by out-of-state providers.
(b) Notwithstanding any inconsistent provision of this section, in the event the department determines that an out-of-state provider is providing services that are not available within New York State, the department may negotiate payment rates and conditions with such provider; provided however, such payments shall not exceed the provider´s usual and customary charges for such services.
(c) For purposes of this section, the downstate region of New York State shall consist of the New York counties of Bronx, New York, Kings, Queens, Richmond, Nassau, Suffolk, Westchester, Rockland, Orange, Putnam and Dutchess, and the upstate region of New York State shall consist of all other New York counties.
